Fixation devices such as screws are often used in orthopedic procedures to stabilize the bone and facilitate tissue healing. Often, it is necessary to incorporate sutures in these orthopedic repairs for additional fixation. However, existing suture fixation devices for some procedures such as, for example, ankle syndesmosis can have a large knot stack after tying, causing soft tissue irritation. Knots may also slip and relax over time requiring additional operations.